Prognostic impact of diabetes mellitus on patients managed by urgent percutaneous coronary intervention

Introduction:Diabetes Mellitus (DM) is known to be associated with worse outcomes following percutaneous coronary intervention (PCI). Aim:To assess prognostic impact of DM on patients managed by urgent PCI following ST-segment elevation myocardial infarction (STEMI). Methods:In a retrospective study, STEMI patients admitted to our department from January 2016 to December 2019 and treated with urgent PCI (primary or rescue PCI) were included. They were divided in two groups: Diabetic and non-diabetic patients. They were followed-up for a period of 12 months. Major cardiac adverse event (MACE) was a composite outcome of the following events: myocardial infarction, target vessel revascularization, target lesion revascularization or cardiovascular death. MACEs were collected during follow-up. Results: Our population consisted of 225 patients. DM was observed in 104 STEMI patients (46.2%). Diabetic patients had higher frequency of hypertension (p<0.001), low-density lipoprotein cholesterol levels > 1.4mmol/l (p<0.001) and chronic kidney disease (CKD) (p=0.009). In-hospital and 12-months mortality were significantly higher in the diabetic group (11.5% versus 4.1%; p=0.036) and (24.7% versus 8.7%; p=0.003). In-hospital and 12-months MACEs were also more frequent among diabetic patients (17.3% versus 6.7%; p=0.013) and (43.5% versus 17.5%; p<0.001). Main factors associated with in-hospital mortality among diabetic patients were age > 75 years, anemia, CKD, cardiogenic shock and procedural failure. Age > 75 years, hyperglycemia at admission (>10mmol/l), extensive anterior infarction and procedure failure were associated with in-hospital mortality in the non-diabetic group. Factors associated with 12-months mortality and MACEs among diabetic patients were age > 75 years, anemia, CKD and left ventricular systolic dysfunction. Conclusions:Despite modern era of STEMI treatment, diabetic patients still have a poor prognosis. These results highlight the need for coronary risk factors treatment among these patients.     

Acute heart failure following severe chloralose poisoning: A case report

Self-poisoning with alpha chloralose is frequent in Tunisia. Neurological signs are prominent involving myoclonic jerks and coma. Cardiac toxicity is not well known.We report the case of a 19 year-old woman who ingested a chloralose rodenticide and was admitted to our intensive care unit. Four hours after admission she developed acute heart failure with pulmonary edema and elevated troponin. Echocardiography showed diffuse hypokinesia. Patient’s cardiac and respiratory status improved progressively and echocardiography performed 5 days after was normal.Cardiac toxicity following acute chloralose poisoning is uncommon and potentially serious. Its mechanism is poorly understood.     

Sacrum B cell-non-Hodgkin's lymphoma complicating a chronic viral hepatitis C related to a blood exposure: a case report

Frequency of the association between non-Hodgkin's lymphoma (NHL) and the hepatitis C virus (HCV) infection is variable according to previous studies. Besides, direct and/or indirect implication of the HCV infection in the development of NHL is probable but, its pathophysiological mechanisms remain unclear. In this report, we described the case of a 49-year-old patient with a B-cell NHL of the sacrum complicating a chronic HCV related to a blood exposure, and we report the recent data of this association.     

Oxidative stress induced by chromium (VI) in bone of suckling rats

Exposure to hexavalent chromium Cr(VI) compounds is of concern in many Cr-related industries and their surrounding environments. K(2)Cr(2)O(7) is widely recognized as an animal and human carcinogen, mutagen, and teratogen. The present study investigated the bone maturity of suckling rats whose mothers were treated with K(2)Cr(2)O(7). Experiments were carried out on female Wistar rats given 700 ppm of K(2)Cr(2)O(7) in their drinking water from the 14th day of pregnancy until day 14 after delivery. Exposing dams to K(2)Cr(2)O(7) caused disorders in the bone of their progeny. As corollary to this, malondialdehyde levels increased, while glutathione, a non-protein thiol and vitamin C decreased. Alteration of the antioxidant system in the treated group was also confirmed by the significant decline of superoxide dismutase, catalase, and glutathione peroxidase activities. Furthermore, K(2)Cr(2)O(7) induced changes in bone mineralization, especially calcium and phosphorus levels, which decreased. Whereas, in plasma and urine, they increased and decreased inversely. These results suggest that K(2)Cr(2)O(7) accelerated bone resorption activity. In fact, in treated pups, total tartrate-resistant acid phosphatase, which reflected bone resorption, was enhanced while total alkaline phosphatase, which reflected bone formation, was reduced. The impairment of bone function was corresponded histologically.     

Le lupus tuberculeux

Cutaneous tuberculosis accounts for 2% of all extrapulmonary tuberculosis and is one of the multiple clinical presentations of extrapulmonary tuberculosis. We report a case of cutaneous tuberculosis with unusual clinical and histological presentations.